Nagira Keita, Ogoshi Tomofumi, Akahori Keiichi, Enokida Shinpei, Enokida Makoto, Ueda Takahiro, Homma Masato, Nagashima Hideki
Department of Orthopedic Surgery, Faculty of Medicine, Tottori University, 36-1 Nishi-Cho, Yonago, Tottori, 683-8504, Japan.
Department of Emergency and Disaster Medicine, Tottori University, Tottori, Japan.
Langenbecks Arch Surg. 2023 May 11;408(1):189. doi: 10.1007/s00423-023-02929-x.
Necrotizing soft-tissue infection (NSTI) is a surgical emergency associated with high mortality. This study primarily aimed to identify the factors associated with in-hospital mortality due to NSTI in the extremities at a single institution. Secondarily, we aimed to clarify the effectiveness of the optimal combination of hyperbaric oxygen therapy (HBOT) and surgery for NSTI treatment.
Retrospective observational study.
This study included all patients newly diagnosed with NSTI in the extremity from 2003 to 2021 in our hospital. Factors associated with mortality, including patient's characteristics, duration from onset to hospitalization, NSTI type, and clinical data at the initial visit; acute disseminated intravascular coagulation (DIC), laboratory risk indicator for necrotizing fasciitis score, and sequential organ failure assessment score; treatment, initial surgery, surgery times, amputation, HBOT, combined surgery with HBOT, and clinical outcomes; amputation rate, mortality rate, and hospitalization duration were examined.
A total of 37 cases were treated for NSTIs. The median age was 64 years (range: 22-86). Five cases (13.5%) died during hospitalization. Ten patients were diagnosed with DIC at the initial visit, of whom four died. HBOT combined with surgery was performed in 23 cases, and 16 cases underwent multiple surgeries. Factors associated with mortality included DIC (p = 0.015, 95% confidence interval [CI]: 0.015-0.633) and multiple surgeries combined with HBOT (p = 0.028, 95% CI: 1.302-95.418).
This study demonstrates that DIC at the initial visit is associated with mortality in extremity NSTI. Additionally, HBOT might improve prognosis when combined with multiple surgeries.
坏死性软组织感染（NSTI）是一种与高死亡率相关的外科急症。本研究主要旨在确定在单一机构中与肢体NSTI院内死亡相关的因素。其次，我们旨在阐明高压氧治疗（HBOT）与手术的最佳组合对NSTI治疗的有效性。
回顾性观察研究。
本研究纳入了2003年至2021年在我院新诊断为肢体NSTI的所有患者。研究了与死亡率相关的因素，包括患者特征、发病至住院的时间、NSTI类型以及初诊时的临床数据；急性弥散性血管内凝血（DIC）、坏死性筋膜炎评分的实验室风险指标以及序贯器官衰竭评估评分；治疗、初次手术、手术次数、截肢、HBOT、手术联合HBOT以及临床结局；截肢率、死亡率和住院时间。
共治疗了37例NSTI患者。中位年龄为64岁（范围：22 - 86岁）。5例（13.5%）患者在住院期间死亡。10例患者在初诊时被诊断为DIC，其中4例死亡。23例患者接受了HBOT联合手术，16例患者接受了多次手术。与死亡率相关的因素包括DIC（p = 0.015，95%置信区间[CI]：0.015 - 0.633）和多次手术联合HBOT（p = 0.028，95% CI：1.302 - 95.418）。
本研究表明初诊时的DIC与肢体NSTI的死亡率相关。此外，HBOT与多次手术联合使用可能会改善预后。
